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903 Septic Perc Tests & Plan 2000 ILea I V-4.:_!:::;-.;./7": Il PERCOLATION TEST(S) Time: Time: Observation Hole #1 Observation Hole #2 Depth of Perc n ti Depth of Perc Start Pre-soak Start Pre-soak End Pre-soak End Pre-soak ii ; Time at 17 Time at 12" Time at 9° i Time at 9' Time at 6" Time at 6' Time(9"—6') Tme(9"—6") Rate Min./Inch Rate Min./Inch 'minimum of 1 percolation test must be performed in-oth the primary area AND reserve area. • ..._:_.. ■ • • Performed by I Performed by Witnessed by Witnessed by Comments: J:_. _ • j NORTHAMPTON BOARD of HEALTH- Title 5- Site Review Location Address or Lot# ,ii / Owner r /, dip i � _ i� - Date Time D 1 4) Soil Holton Owner's Address Sol Color (Munsell) Engineer I /IWptti Weather Phone M., Land Use Y Slope Surface Stones Landform Ve!etation Start Time PmiEm at Landscape(sketch Open Water Body co the bark) feet Distances Stop Time Drinking Water Well feet Property Line feet Possible Wet Area feet Drainage Way feet Other feet DEEP OBSERVATION HOLE LOG* Deep Hole N: 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth from Surface(lathes) Soil Holton Soil Texture (USDA) Sol Color (Munsell) Soi Motf g Other (Structure,Stones.Boulders.Consistency,%Greveg L Ii v r� 1 02,6501/ I I/ Parent Mabial(geabglo) I I Depth to Bedrock Depth to groundwater: Standup Waterinthe Hole ),i6),/'i-_. I Weeping from Pit Face Estimated Seasonal High Ground Water DEEP OBSERVATION HOLE LOG` Deep Hole N: MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth from Surface prates) Sal Holton Sail Texture (USDA) Sal Color (Mansel) Soil Mottling Other (Structure,Stones,Boulders,Consstency,%Gravel) Parent Mahal(geologc) I I Depth to Bedrock Depth to gr undwater Standing Water in the Hole I Weeping from Pit Face Estim ted Seasonal High Ground Water Property Addr Owner: Dee of SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTON FORM PART C SYSTEM INFORMATION(continued) ?8 t4 %L tat-,.,,,,,4 "//4,/,t SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate ell wells w'thin 100' (Locate where public wetee supply comes into house) revised 9/2/56 35 46 &zn W-ov-xz. - 3 AC 6 ,0 Page 10 of 11